{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:43:31Z","timestamp":1792226611640,"version":"4.4.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Minimally invasive surgery is the standard approach for colorectal cancers and requires an abdominal incision for specimen removal. Natural orifice specimen extraction (NOSE) may improve outcomes, reducing trauma, and speeding postoperative recovery. This study compares both techniques regarding postoperative complications, operative outcomes, and recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We searched PubMed, Scopus, and Cochrane Central Register of Clinical Trials for studies published up to November 2024. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model, and heterogeneity was assessed with\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistics. Statistical analyses were conducted using R Software version 4.4.1 (R Foundation for Statistical Computing).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Four randomized controlled trials involving 439 patients with colorectal cancer were included, with 212 (48.2%) undergoing NOSE and 227 (51.7%) undergoing conventional laparoscopic specimen extraction. NOSE significantly reduced postoperative pain (visual analog scale score: mean difference [MD] \u22121.8; 95% confidence interval [CI] \u22122.5 to \u22121.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01), time to pass flatus (MD \u22120.8; 95% CI \u22121.1 to \u22120.6;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01), and surgical site infection rates (OR 0.15; 95% CI 0.03\u20130.69;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .015) but was associated with a longer operative time (MD 11.1 minutes; 95% CI 1.5\u201320.6;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .02). No significant differences were observed between the groups in bowel leaks, lymph nodes harvested, intraoperative blood loss, hospital stay duration, or local recurrence rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>NOSE was associated with reduced postoperative pain, faster time to pass flatus, and lower infection rates but required longer operative time than conventional laparoscopic specimen extraction. Other outcomes, including complications, operative characteristics, and recurrence, showed no significant differences between the techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/lap.2025.0003","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T11:32:58Z","timestamp":1743161578000},"page":"379-387","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Natural Orifice Extraction Techniques (Natural Orifice Specimen Extraction and Natural Orifice Transluminal Endoscopic Surgery) for Left-Sided Colorectal Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2960-3810","authenticated-orcid":false,"given":"Bernardo Fontel","family":"Pompeu","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."},{"name":"School of Medicine, University of S\u00e3o Caetano do Sul, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiza Soares","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Soares de Souza Pinto","family":"Guedes","sequence":"additional","affiliation":[{"name":"School of Medicine, University of S\u00e3o Caetano do Sul, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia Hoici","family":"Brunini","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7687-3073","authenticated-orcid":false,"given":"Lucas Monteiro","family":"Delgado","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio Mazzola","family":"Poli de Figueiredo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Bellotti","family":"Formiga","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Heliopolis Hospital, S\u00e3o Paulo-SP, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.06.022"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"issue":"5","key":"e_1_3_5_4_2","first-page":"1817","article-title":"Comparison of efficacy between natural orifice specimen extraction without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer","volume":"24","author":"Ding Y","year":"2019","unstructured":"Ding Y, , Li Z, , Gao H, et al. Comparison of efficacy between natural orifice specimen extraction without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer. J BUON, 2019; 24(5):1817\u20131823.","journal-title":"J BUON"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2163-x"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.03.064"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09435-z"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.7758"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-011-2066-6"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01655705"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-08250-8"},{"key":"e_1_3_5_12_2","unstructured":"Zhao F Zhao W Xiao T et al. Evaluating short-term and survival outcomes of natural orifice specimen extraction surgery for colorectal cancer: A single-centre retrospective study. Frontiers in Surgery [Internet]. 2023; 10. Available from: https:\/\/www.scopus.com\/inward\/record.uri?eid=2-s2.0-85149777515&doi=10.3389%2ffsurg.2023.1078316&partnerID=40&md5=15b6e61082e9212d88ab0243f29817cd"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9757"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/6661651"},{"key":"e_1_3_5_15_2","unstructured":"Brincat SD Lauri J Cini C. Natural orifice versus transabdominal specimen extraction in laparoscopic surgery for colorectal cancer: Meta-analysis. BJS Open [Internet]. 2022; 6(3). 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